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Good news Refined, improved prostate cancer treatment options help patients

No matter what treatment method they choose, there's good news for men facing a prostate cancer diagnosis.

Dr. Eric Dybal
Dr. Eric Dybal, board-certified urologist and American Cancer Society medical ambassador, says that no matter which treatment option men choose, they can expect to fare better than ever before.

Dr. Eric Dybal, board-certified urologist and American Cancer Society medical ambassador, says that no matter which treatment option men choose, they can expect to fare better than ever before.

"Refined and improved treatment techniques definitely mean good news," says Dr. Dybal, on staff at three suburban hospitals including Alexian Brothers Medical Center, Northwest Community Hospital and St. Alexius. "While there isn't necessarily one "best" option, there are many "good" ones."

Deciding on the best course of action can be a difficult decision, requiring careful study, physician recommendation, a second opinion and family considerations, he says.

"If you have prostate cancer," Dr. Dybal says, "there are many important factors to take into account before deciding on a treatment option, such as your age and general health, and the likelihood that the cancer will cause problems for you."

Weighing pros and cons

According to the ACS, prostate cancer is a malignancy that develops in the cells of the prostate gland and the second leading cause of cancer death in men. Some 186,320 men can expect to learn of their own diagnosis this year. In Illinois, 8,080 men will be diagnosed with the disease and more than 1,380 will die.

Most doctors concur that external radiation, radical prostatectomy, and brachytherapy (radioactive implants) have about the same cure rates for the earliest stage prostate cancers. However, there are pros and cons to each type of treatment that should be considered, including possible risks and side effects.

Decision making is complicated even further by the explosion of newer types of surgery (laparoscopic and robotic-assisted prostatectomys) and radiation therapy (conformal radiation therapy, intensity-modulated radiation therapy and proton beam radiation) in recent years.

Examining the options

Treatment options, says Dr. Dybal, who has been in practice for 13 years, depend in part on tumor staging and whether the tumor has spread. Current treatment options include:

• Radical prostatectomy, is a surgical procedure removing the whole prostate gland and nearby lymph nodes. A new robotic da Vinci surgical system - literally a robot controlled by a surgeon - is performing complex surgery movements using a minimally invasive approach at a handful of Metropolitan Chicago hospitals. Robotic surgery results to date, many surgeons say, are dramatic, with patients experiencing less postoperative pain, quicker recovery and healing.

• Radiation therapy (External Beam Radiation EBRT) uses high-energy rays or particles to kill cancer cells. Radiation is sometimes used as the initial treatment for low-grade cancer still confined within the prostate gland or that has only spread to nearby tissue. Cure rates for men with these types of cancers are much like those for men getting radical prostatectomy surgery. Radiation is also sometimes used if the cancer is not completely removed or recurs in the area of the prostate after surgery. If the disease is more advanced, radiation may be used to reduce the size of the tumor and provide relief from present and possible future symptoms.

1. In EBRT, the radiation is focused on the prostate gland from a source outside the body. It is much like getting an x-ray but for a longer time.

2. Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT uses special computers to precisely map the location of the prostate. Although the procedure is fairly new, short-term results suggest it is at least as effective as standard radiation therapy.

3. Intensity modulated radiation therapy (IMRT): IMRT is an advanced form of 3D therapy, using a computer-driven machine that moves around the patient as it delivers radiation. In addition to shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to minimize the dose reaching the most sensitive normal tissues. This allows doctors to deliver an even higher dose to cancer areas.

4. Conformal proton beam radiation therapy: Proton beam therapy is related to 3D-CRT and uses a similar approach. But instead of using X-rays, this technique focuses proton beams on the cancer. Protons are positive parts of atoms. Unlike X-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through, releasing their energy after traveling a certain distance. This means that proton beam radiation may be able to deliver more radiation to the prostate and do less damage to nearby normal tissues.

• Radiation (brachytherapy, also called seed implantation or interstitial radiation therapy) is a procedure involving the use of small radioactive pellets or "seeds," each about the size of a grain of rice, placed directly into the prostate.

• Hormonal Therapy (also called androgen deprivation therapy (ADT) or androgen suppression therapy) is designed to reduce levels of the male hormones, called androgens, in the body. Androgens such as testosterone and dihydrotestosterone (DHT) are produced mainly in the testicles, and stimulate growth of prostate cancer cells. Lowering androgen levels often makes prostate cancers shrink or grow more slowly. However, hormone therapy does not cure prostate cancer.

• Cryotherapy (also called cryotherapy or cryoablation) is sometimes used to treat localized prostate cancer by freezing it.

• Watchful waiting, involves no treatment until tumors grow larger. Because prostate cancer often grows very slowly, some men - especially those who are older or have other serious health problems - may never need treatment. Instead, through expectant management or "watchful waiting," doctors closely monitor the cancer without active treatment such as surgery or radiation therapy.

Although not currently available in this country, new treatment options such as high intensity, focused ultrasound (HiFu) and partial radiation are being pioneered in places like Canada, Europe and Mexico, says Dr. Dybal.

'It came out of the blue'

"I needed a plan."

That's how prostate cancer survivor and Palatine resident Frank Maher, 69, described his reaction after receiving his cancer diagnosis nearly seven years ago.

Frank Maher
Frank Maher, 69, of Palatine, opted for surgery to treat his prostate cancer.

"It came out of the blue, and I needed options," recalls the 69-year-old father of three and grandfather of 10, also a member of the American Cancer Society's (ACS) Men's Health Task Force.

"I'd been having the prostate-specific antigen (PSA) blood screening exam for years, ever since being diagnosed with an inflammation," Maher says.

"I guess I always assumed the numbers would be the same. Unfortunately, according to my doctor, that wasn't the case."

Maher says his 2001 physical exam probably saved his life.

"An ultrasound exam and subsequent biopsy confirmed everything," says Maher, whose healthy lifestyle had included bicycling and successfully kicking his cigarette habit. "I had prostate cancer, and my initial reaction was I wanted it out."

"Early diagnosis and treatment can be a matter of life and death," says Maher, whose diagnosis left him spinning. "I needed a plan, and right away involved my family in learning all we could and helping with my decision. "

Maher says he initially suspected surgery was his option of choice.

"After talking with my doctor and getting a second opinion, I was even more convinced," said the retired advertising executive, currently working at The Garlands in Barrington.

"I remember taking my wife, Joanne, and son, Frank, along to the initial consult to learn all the pros and cons. Together, we decided on the surgical option and later went out to lunch. It was a no-brainer."

Maher's September 2001 radical prostatectomy surgery, at Northwest Community Hospital in Arlington Heights, was a success.

"My doctor says he found more cancer than he originally suspected, but was pleased when lymph node biopsy results came back clear," said Maher, a lector at St. Thomas of Villanova parish in Palatine and volunteer lector at Addolorata Villa nursing home.

"It was important for me to always have a positive attitude and get back as soon as possible to living my life in a normal fashion."

Since surgery, Maher has stepped up his daily exercise regimen - working out three days a week on his exercise bike, lifting weights and swimming up to 10 laps at the health club.

A space-age pioneer

Harold Hagenson, 71, of Grayslake never considered himself a trailblazer, but he is somewhat of a space-age pioneer. In November 2006, the father of five and retired tool and die maker opted for robotic surgery to remove his prostate.

Harold Hagenson
Harold Hagenson, 71, of Grayslake, opted for robotic surgery for his cancer.

Did you know?

Two-thirds of cancers can be prevented by lifestyle changes and early detection. More than half of all new cancers can be detected early.

The da Vinci robot is in use at a number of suburban hospitals, including Advocate Lutheran General Hospital, where Hagenson had his surgery this past February.

Able to perform complex surgery movements using a minimally invasive approach, the robot is making waves and offering surgeons another tool in their arsenal of options for cancer surgery.

Diligent about his annual checkups, Hagenson was initially shocked when PSA numbers rose suddenly to abnormal levels. A subsequent biopsy helped pinpoint nine cancerous growths in 12 samples.

"My urologist reviewed all the options available to me, including removing my prostate using the robotic approach," he said. "Additional scans showed the tumor was localized, and that made the decision for surgery very easy."

Hagenson says a DVD helped him better understand the procedure.

"I learned that the benefits of robotic surgery as opposed to the traditional invasive surgery included a shorter hospital stay, considerably less discomfort and scarring, lower risk of infection, less blood loss and faster recovery," Hagenson said. "That was true in my case."

After spending only one night in the hospital, Hagenson returned home with five small incisions, each no larger than the diameter of a dime.

"Receiving the news of an elevated PSA requires men to be proactive," Hagenson explains.

"Together with your doctor, it's important to determine the extent of the malignancy, and if removal is a viable option, I'd highly recommend robotic surgery."

The robot, which has been used for the minimally invasive radical prostatectomy procedures for several years, is again making news as variations on the same technique make it possible to expand usage.

Robotic arms are controlled by a surgeon, mimicking the surgeon's movements.

Hand, wrist and finger movements are seamlessly translated into precise, real-time movements of surgical instruments inside the patient. Telescopic magnification increases the surgeon's field of vision up to 10 times, enhancing accuracy and precision.

As surgeons can more accurately perform complex surgical maneuvers through small "ports," patients have less need for large, traumatic incisions and experience less post-operation pain and discomfort.


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